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•� ' APPLICATION FOR SANITATION PERMIT Permit No.dol....... <br /> �` (Complete in Duplicate) <br /> Hate Issued---"-a. ...... <br /> Application is hereby made to the.San-Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Or ante No. 544 <br /> JOB ADDRESS A CATION. C 5.•. ..... _ <br /> 1„ <br /> - -- ---------------------------------------------------___........---­--­--------------- <br /> Owner's <br /> - -------- ------- <br /> Owner's Nagle,_ E - - -- ------ - ------ -------- ---- !- i Phone <br /> Address... -.4 <br /> Contractor's Name--- --- ----- Phone ---_-- ----- ..5 <br /> Installation will serve: Residence C] Apartment House Commercial F1Trailer Court ❑ Motel ❑ Other ❑, 1w `> <br /> Number of living units: Z_ Number of bedrooms __ Numberaths .Z Lot siz ,_-7C4__ <br /> Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ___ ft. ` <br /> t4 <br /> Character of soil to a depth of 3 feet: Sand F.,I Gravel ❑ Sandy Loam Clay Loam ❑ Clay❑ Adobe(f�Hardpan ,y+ ' <br /> Previous Application Made:= Yes [_] No R/ New Construction: Yes No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well...-. -----Distance from foundation_._--___ -.-_-----Material----___.-_--____ <br /> ❑ No. of partments._. __ Size--------------------------------Liquiddepth -------- --------_Capacity----------- <br /> Disposal Field: Distance from nearest well Distance from foundation Distance to nearest lot line <br /> .$ Number of lines ______ _____________ ___Length of each line------------------------------Width of trench___-____- __-_...______.__ <br /> Type . ___- ----Depth of filter material -----I Total length----- -------- ------- --/ <br /> Seepage Pit: Distance to nearest we <br /> o material: <br /> ff <br /> II Distance o foun tion--!v0_ -,Distance fo ------ <br /> nearest lof ' e-. R.. <br /> ❑ Number of pits_ __________[._____Lining material.____-_. ize: Diameter-. ------.Depth..-_.- .-__.. <br /> Cesspool. • Distance from nearest well____ _________Distance from foundation--------------------Lining material......... <br /> Size: Diameter-- _-----.:_ Depth---- --------- --_ -_.----_Liquid,Capacity �`-_-- �V <br /> Privy: Distance from nearest well____________________________ <br /> .. Distance from nearest building-------------------------------- <br /> Distance <br /> ____ _________ _________Distance to nearest lot line----------------------------------------------------_ ------- ------- --------------- <br /> ------------------------------------ <br /> Remodeling <br /> ------ - -Remodeling and/or repairing (describe)----------------- ----------------•--- ------- ------ <br /> - <br /> �a <br /> ----- •----- ----------- ----- ----- <br /> ----------------------------------------------- -•-- -- -------- - ----------------------------------------------------------------------------------------------------. . ---•-- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Co <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> a � <br /> (Signed) ------ <br /> - ----------_----(Owner and/or Contra ' <br /> ---------� - ------------ ----- ------- -- ----------------- <br /> --- --- --••-(Title)- --------- ------ ------- ------ �». <br /> (Plot plan, showing size of to , location of system in elation to a Is, buildings, etc., can be placed on reverse side). ,n <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-- -- ------- ------- ------ --------------------------------------•-----. DATE_- _--------......... <br /> REVIEWEDBY-------------------------------- -- --------------------------------------------------------- ---------- DATE.__ 3 <br /> - <br /> BUILDING PERMIT ISSUED-------------------------------- <br /> DATE -------- <br /> Alterations and/or recommendations --- ---- --• -. -------- --------------------------------------- --- <br /> ----------­­-­------­---­----------------------------------------------------- <br /> FINAL <br /> - _ -----.-.FINAL INSPECTION BY.` \,N..__------- ---------------------------- Date-----------).-- -------/.�....... <br /> _... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M 8-51 Revised W-2100 <br />